LEILA EVANS
Dependent on policy B04M000722
Claims
2
Attributed to this person
Charged
1,171.00
Total submitted
Denied
378.00
1 denied claims
Patient responsibility
0.00
Reported on the 835
Patient responsibility is the amount reported on the 835 as assigned to the patient — deductible, coinsurance or copay. It is not proof that the provider billed the member, that the member owes it, or that it was collected, and it is kept separate from denied amounts throughout.
Who this is
| Field | Value |
|---|---|
| Name | LEILA EVANS |
| Role on the policy | Dependent · relationship 19 |
| Policy | B04M000722 |
| Date of birth | 19 Jan 1994 |
| Plan | PLATINUM PPO |
| Covered from | 5 Apr 2024 |
| Covered to | 17 Nov 2024 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003146 | 21 Apr 2024 | 378.00 | MERIDIAN HEALTH PLAN | CARC 197 · AUTHORIZATION | 378.00 |
| CLM0003147 | 17 Apr 2024 | 793.00 | MERIDIAN HEALTH PLAN | Not denied | — |